D‐dimer levels in maintenance hemodialysis patients: High prevalence of positive values also in the group without predisposing diseases

Gubenšek, Jakob; Lolic, Matea; Ponikvar, Rafael; Buturović‐Ponikvar, Jadranka

doi:10.1111/hdi.12371

Cited by 17 publications

(18 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…D-dimer also increases in severe COVID-19 patients, indicating vascular damage. However, D-dimer is a marker that is elevated in dialysis patients [13,33].…”

Section: Discussionmentioning

confidence: 99%

The Spectrum of Clinical and Serological Features of COVID-19 in Urban Hemodialysis Patients

Cunha

Gomá-Garcés

Avello

et al. 2020

JCM

View full text Add to dashboard Cite

Introduction: The inherent immunosuppression of uremia increases the susceptibility of hemodialysis patients to infection. There is still limited evidence on hemodialysis patients and COVID-19. The clinical and analytical spectrum and treatment responses and mortality are poorly characterized. Material and Methods: Clinical and analytical features, chest X-ray, polymerase chain reaction (PCR) and antibodies for SARS-CoV-2, treatment and outcomes were analyzed in 48 patients diagnosed with COVID-19 during March and April 2020 in two coordinated Spanish hemodialysis units. Results: In 200 haemodialysis patients, COVID-19 was diagnosed in 48, of whom 22 were PCR positive, eight PCR negative but seroconverted and two were diagnosed on typical clinical grounds. Despite a mean age of 72.6 years, the overall mortality rate was 5/48 (10%). Among the PCR positive patients, 21 (55%) required admission and five (13%) died. PCR positive patients were more often symptomatic and hospitalized and had higher troponin I levels than PCR negative patients, but did not differ in lymphocyte counts, D-dimer or interleukin-6 (IL-6) levels. Among PCR negative COVID-19 patients, three out of 10 (30%) required admission, and none died. The most frequent symptom among the 48 patients was fever (31%), followed by asymptomatic patients (23%). A low number of lymphocytes was the only parameter significantly different between hospitalized and ambulatory COVID-19 patients, independently of PCR status. Conclusions: COVID-19 hemodialysis patients are frequently asymptomatic, and mortality may be lower than previously reported. Diagnosis may be retrospective, based on seroconversion, as PCR may be negative. This information should guide preventive and patient isolation strategies.

show abstract

“…D-dimer also increases in severe COVID-19 patients, indicating vascular damage. However, D-dimer is a marker that is elevated in dialysis patients [13,33].…”

Section: Discussionmentioning

confidence: 99%

The Spectrum of Clinical and Serological Features of COVID-19 in Urban Hemodialysis Patients

Cunha

Gomá-Garcés

Avello

et al. 2020

JCM

View full text Add to dashboard Cite

show abstract

“…Secondly, due to data limitations, we could not exclude all of the oral and hemostatic anticoagulants that participants were taking as a potential confounder and bias affecting the results [32, 33]. Other additional markers for coagulation activity such as D-dimer and fibrinogen [34, 35], which would be residual confounders, were not tested in this study.…”

Section: Discussionmentioning

confidence: 99%

Modified regional citrate anticoagulation is optimal for hemodialysis in patients at high risk of bleeding: a prospective randomized study of three anticoagulation strategies

et al. 2019

View full text Add to dashboard Cite

BackgroundRecommended regular saline flushing presents clinical ineffectiveness for hemodialysis (HD) patients at high risk of bleeding with heparin contraindication. Regional citrate anticoagulation (RCA) has previously been used with a Ca2+ containing dialysate with prefiltered citrate in one arm (RCA-one). However, anticoagulation is not always achievable and up to 40% results in serious clotting in the venous expansion chamber. In this study, we have transferred one-quarter of the TSC from the prefiltered to the post filter based on RCA-one, which we have called RCA-two. The objective of this study was to compare the efficacy and safety of RCA-two with either saline flushing or RCA-one in HD patients with a high bleeding risk.MethodIn this investigator-initiated, multicenter, controlled, prospective, randomized clinical trial, 52 HD patients (77 sessions) were randomized to the RCA-2 and RCA-one group in part one of the trial, and 45 patients (64 sessions) were randomized to the RCA-2 and saline group in part two of the trial. Serious clotting events, adverse events and blood analyses were recorded.ResultsSerious clotting events in the RCA-two group were significantly lower compared with the RCA-one and saline group (7.89% vs. 30.77%, P = 0.011; 3.03% vs. 54.84%, P < 0.001, respectively). The median circuit survival time was 240 min (IQR 240 to 240) in the RCA-two group, was significantly longer than 230 min (IQR 155 to 240, P < 0.001) in the RCA-one group and 210 min (IQR 135 to 240, P = 0.003) in the saline group. The majority of the AEs were hypotension, hypoglycemia and chest tightness, most of which were mild in intensity. Eight patients (20.51%) in the RCA-one group, 4 patients (12.90%) in the saline group and 10 patients (26.31%) in the RCA-two group, P > 0.05.ConclusionsOur data demonstrated that the modified anticoagulation protocol was more effective and feasible during hemodialysis therapy for patients at high risk of bleeding.Trial registrationGDREC, GDREC2017250H. Registered February 2, 2018; retrospectively registered.

show abstract

“…The elevated Ddimer levels documented in ESKD patients [36,37] have not previously been associated with increased mortality. However, elevated D-dimer levels correlate with the severity of atherosclerotic burden and history of peripheral vascular disease [38][39][40][41][42]. Studies related to uncovering mechanisms for COVID-19 thrombotic complications are of extreme interest and ongoing [29,30].…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of COVID-19 Infection in Hospitalized End-Stage Kidney Disease Patients in a Predominantly African-American Population

et al. 2021

View full text Add to dashboard Cite

Background: End-stage kidney disease patients on dialysis are particularly susceptible to COVID-19 infection due to comorbidities, age, and logistic constraints of dialysis making social distancing difficult. We describe our experience with hospitalized dialysis patients with COVID-19 and factors associated with mortality. Methods: From March 1, 2020, to May 31, 2020, all dialysis patients admitted to 4 Emory Hospitals and tested for COVID-19 were identified. Sociodemographic information and clinical and laboratory data were obtained from the medical record. Death was defined as an in-hospital death or transfer to hospice for end-of-life care. Patients were followed until discharge or death. Results: Sixty-four dialysis patients with COVID-19 were identified. Eighty-four percent were African-American. The median age was 64 years, and 59% were males. Four patients were on peritoneal dialysis, and 60 were on hemodialysis for a median time of 3.8 years, while 31% were obese. Fever (72%), cough (61%), and diarrhea (22%) were the most common symptoms at presentation. Thirty-three percent required admission to intensive care unit, and 23% required mechanical ventilation. The median length of stay was 10 days, while 11 patients (17%) died during hospitalization and 17% were discharged to a temporary rehabilitation facility. Age >65 years (RR 13.7, CI: 1.9–100.7), C-reactive protein >100 mg/dL (RR 8.3, CI: 1.1–60.4), peak D-dimer >3,000 ng/mL (RR 4.3, CI: 1.03–18.2), bilirubin >1 mg/dL (RR 3.9, CI: 1.5–10.4), and history of peripheral vascular disease (RR 3.2, CI: 1.2–9.1) were associated with mortality. Dialysis COVID-19-infected patients were more likely to develop thromboembolic complications than those without COVID-19 (RR 3.7, CI: 1.3–10.1). Conclusion: In a predominantly African-American population, the mortality of end-stage kidney disease patients admitted with COVID-19 infection was 17%. Age, C-reactive protein, D-dimer, bilirubin, and history of peripheral vascular disease were associated with worse survival.

show abstract

D‐dimer levels in maintenance hemodialysis patients: High prevalence of positive values also in the group without predisposing diseases

Cited by 17 publications

References 23 publications

The Spectrum of Clinical and Serological Features of COVID-19 in Urban Hemodialysis Patients

The Spectrum of Clinical and Serological Features of COVID-19 in Urban Hemodialysis Patients

Modified regional citrate anticoagulation is optimal for hemodialysis in patients at high risk of bleeding: a prospective randomized study of three anticoagulation strategies

Epidemiology of COVID-19 Infection in Hospitalized End-Stage Kidney Disease Patients in a Predominantly African-American Population

Contact Info

Product

Resources

About